AB0496 TREATMENT WITH UPADACITINIB IN RA PATIENTS FOR WHICH BIOLOGICAL THERAPY FAILED
Authors: L. Robles Kirkegard, E. Rubio Romero, P. León
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Upadacitinib is a JAK inhibitor recently approved for rheumatoid arthritis treatment with promising results in its studies for severe moderate RA for which conventional therapies failed. <h3>Objectives</h3> To study and describe the evolution of patients diagnosed with RA and treated with Upadacitinib who had inadequate response to biological therapy in association or not with DMARDs and GC for 1 year. <h3>Methods</h3> A population of 23 patients (19 of them female) with RA on treatment with Upadacitinib was analyzed over 1 year. Using patient-reported outcomes (PROs) to measure disease activity by visual analogue scale (VAS), the HAQ Disability Index (HAQ-DI), Disease Activity Score (DAS28), and morning stiffness duration. The age´s (average ± SD) = 53 ± 10 years and time of disease evolution (average ± SD) = 17.6 ± 23.3 years. Pretreatment DAS28 was (average ± SD) = 7.32 ± 2.41. The initial VAS was (average ± SD) = 7.32 ± 1.88. HAQ (average ± SD) = 2.2 ± 0.5. All patients received previous biologic treatments and 61% (14 patients) combined therapy with DMARDs. Only 2 cases had no glucocorticoid treatment prior to treatment with Upadacitinib. <h3>Results</h3> In 3 months time, most patients (81%, n = 21) treated with Upadacitinib were able to reduce GC dose, and this reduction was maintained 6 months from the beginning of the treatment. After one year of treatment (n = 14), 71% of patients reduce the dose of GC by 53% with respect to the initial dose. Upadacitinib enabled 50% of patients who initiated treatment to discontinue corticosteroid therapy completely. After 3 months of treatment, most patients experienced an enhancement in DAS28 (89%, n = 18), with an average improvement in DAS28 (average ± SD) = 1.87±1.09 units. After one year of treatment most patients (92%, n = 14) achieve a reduction in DAS28 (average ± SD) = 3.813 ± 1.56 units from baseline. Disease remission (DAS28 &lt;3.2) was achieved in up to 25% of patients who initiated treatment with Upadacitinib. Regarding the pain (VAS), 67% of the patients showed improvement after 3 months (n=18), reaching 71% after 6 months (n=17). After 12 months of treatment (n = 14), 85% of patients experienced an improvement in pain, with the final (average ± SD) VAS being 5 ± 2.32 points. Sixty-eight percent of treated patients showed a reduction in morning stiffness after 3 months (n = 19), and this improvement increased up to 84% of treated patients at 6 months (n = 19) and remained so until 12 months (n = 14). Side effects were observed in five patients, consisting of dizziness and nausea. In no case were they a reason for the withdrawal of the drug. Treatment was withdrawn in three patients due to primary failure. <h3>Conclusion</h3> Treatment with Upadacitinib allows GS dose reduction, as well as an improvement in DAS28, VAS and morning stiffness at three months and six of treatment. These data are in line with the evidence published in Upadacitinib pivotal studies, meaning a good alternative in the treatment of patients with moderate or severe RA. <h3>References</h3> [1]Strand V et al. Upadacitinib improves patient-reported outcomes vs placebo or adalimumab in patients with rheumatoid arthritis: results from SELECT-COMPARE. Rheumatology (Oxford). 2021 Dec 1;60(12):5583-5594. doi: 10.1093/rheumatology/keab158. PMID: 33590829; PMCID: PMC8645276. [2]Nash P. Clinical use of Jak 1 inhibitors for rheumatoid arthritis. Rheumatology (Oxford). 2021 May 5;60(Suppl 2):ii31-ii38. doi: 10.1093/rheumatology/keab265. PMID: 33950231; PMCID: PMC8098107. [3]Avci AB, Feist E, Burmester GR. Early phase studies of JAK1 selective inhibitors in rheumatoid arthritis. Rheumatology (Oxford). 2021 May 5;60(Suppl 2):ii11-ii16. doi: 10.1093/rheumatology/keaa893. PMID: 33950228; PMCID: PMC8098113. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.